Association between SGLT2 inhibitors and recurrence of cerebrovascular events in patients with type 2 diabetes: A population-based cohort study

Objective Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been studied for their effects on cardiovascular disease, cognitive impairment, dementia, Parkinson’s disease, and cerebrovascular disease, with evidence suggesting a reduced risk of mortality. This study aimed to examine the association between SGLT2 inhibitors and cerebrovascular event recurrence. Methods The cohort was extracted from the Korean National Health Insurance Service Database, including individuals aged 19 or older diagnosed with type 2 diabetes. SGLT2 inhibitor users were compared with metformin users using 1:4 propensity score matching. Results Among study subjects, 1563 (7.8%) experienced recurrent cerebrovascular events. SGLT2 inhibitor users showed lower recurrence of cerebral infarction compared to metformin users (adjusted hazard ratio=0.84, p=0.010). Among the types of cerebrovascular diseases, ischemic stroke was associated with a significantly lower risk of recurrence in SGLT2 inhibitor users than metformin users (aHR=0.70, p=0.020). In the SGLT2 inhibitor group, concurrent use of DPP4 inhibitors was associated with a reduced risk of cerebrovascular event recurrence (aHR=0.69, p=0.011). Conclusion SGLT2 inhibitor use was associated with a significantly lower risk of recurrent cerebral infarction compared to metformin, suggesting a potential role in the secondary prevention of cerebrovascular events in patients with type 2 diabetes.